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Papers by Agustina Sciancalepore

Research paper thumbnail of Aneurisma de Aorta Ascendente: ¿Cuál es el Riesgo de Reemplazar la Raíz?

Revista Argentina de Cardiología, 2018

Research paper thumbnail of Utility of Real Time 3D Echocardiography for the Assessment of Left Ventricular Mass in Patients with Hypertrophic Cardiomyopathy: Comparison with Cardiac Magnetic Resonance

Research paper thumbnail of Lateral Left Ventricular Wall Rupture Following Acute Myocardial Infarction: Pathophysiological Interpretation by Multimodality Imaging Approach

Echocardiography, 2014

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial in... more Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.

Research paper thumbnail of Hematoma intramural coronario visualizado en angio-TC multicorte

Revista Española de Cardiología, 2017

Research paper thumbnail of Long-term Outcome of Patients with Hypertrophic Cardiomyopathy

Argentine Journal of Cardiology, 2016

Introduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asocia... more Introduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asociada durante anos a altas tasas de morbimortalidad. Sin embargo, mucha de la informacion que tenemos en relacion a su evolucion proviene de centros en donde se incluyeron pacientes seleccionados, principalmente de alto riesgo. El proposito del siguiente trabajo es evaluar los eventos en el seguimiento de pacientes con MCH en nuestro medio. Metodos: Se evaluo una cohorte retrospectiva de pacientes con diagnostico de MCH. Se evaluo la evolucion de la clase funcional, junto con la ocurrencia de eventos clinicos. Se recabaron datos del ecocardiograma y de la resonancia magnetica cardiaca. Resultados: Se incluyeron un total de 259 pacientes, con una mediana de seguimiento de 3,5 anos (2-10). La edad promedio fue de 56 ± 16,8 anos y un 33 % tenian formas obstructivas. El 67 % de los pacientes estaban asintomaticos al inicio del seguimiento. En la evolucion, la mortalidad global fue del 1,6 %, co...

Research paper thumbnail of Evolución a largo plazo de pacientes con miocardiopatía hipertrófica

Revista Argentina de Cardiología, 2016

espanolIntroduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido... more espanolIntroduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asociada durante anos a altas tasas de morbimortalidad. Sin embargo, mucha de la informacion que tenemos en relacion a su evolucion proviene de centros en donde se incluyeron pacientes seleccionados, principalmente de alto riesgo. El proposito del siguiente trabajo es evaluar los eventos en el seguimiento de pacientes con MCH en nuestro medio. Metodos: Se evaluo una cohorte retrospectiva de pacientes con diagnostico de MCH. Se evaluo la evolucion de la clase funcional, junto con la ocurrencia de eventos clinicos. Se recabaron datos del ecocardiograma y de la resonancia magnetica cardiaca. Resultados: Se incluyeron un total de 259 pacientes, con una mediana de seguimiento de 3,5 anos (2-10). La edad promedio fue de 56 ± 16,8 anos y un 33 % tenian formas obstructivas. El 67 % de los pacientes estaban asintomaticos al inicio del seguimiento. En la evolucion, la mortalidad global fue del 1,...

Research paper thumbnail of Abstract 16508: Fusion of 3D Echocardiography and Computed Tomography for Optimization of Cardiac Resynchronization Therapy

Introduction: A high percentage of patients do not respond to cardiac resynchronization therapy (... more Introduction: A high percentage of patients do not respond to cardiac resynchronization therapy (CRT), because the left ventricular (LV) lead is placed too far from the site of late myocardial activation. Optimal lead placement remains problematic, because different imaging modalities are used to depict coronary anatomy with high spatial resolution and LV wall dynamics with high temporal resolution. We hypothesized that fusion of computed tomography (CT) coronary veins with 3D transthoracic echocardiography (TTE) wall motion timing maps is feasible and may allow measurement of the distances between coronary veins and the site of late activation. Methods: In 9 patients with systolic heart failure (56+8 years, LVEF 34+9%), we obtained 3D full volume TTE of the LV and cardiac CT datasets. Prototype software (TomTec) was used to fuse coronary veins with 3D TTE parametric maps of the timing of LV wall motion superimposed on CT derived 3D endocardial surfaces. Distances were measured betw...

Research paper thumbnail of Hemodynamically significant prosthesis‐patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis

Echocardiography

To evaluate the accuracy of predicted prosthesis‐patient mismatch (PPM) regarding actual PPM meas... more To evaluate the accuracy of predicted prosthesis‐patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction.

Research paper thumbnail of Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

Revista Argentina de Cardiologia

Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsal... more Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of thecoronary arteries or preserving them is still a matter of debate.Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoingaortic root replacement versus aortic root surgery with sinuses of Valsalva preservation.Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoingurgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch,the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root;these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCOREand with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer inthe group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between bothgroups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272).Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years wassimilar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariateanalysis, age and mitral valve disease were identified as predictors of long-term mortality.Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is asafe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate ofevents or mortality at the long-term.

Research paper thumbnail of Desarrollo de un Programa de Oclusiones Totales Crónicas en la República Argentina - Colegio Argentino de Cardioangiólogos Intervencionistas

Revista Argentina de Cardioangiología Intervencionista

Research paper thumbnail of Average Density Of The Psoas Muscle Detected By Multislice Computed Tomography As A Measure Of Fragility In Candidates For Transcatheter Aortic Valve Replacement

Structural Heart

Methods: A cohort of 35 consecutive patients who were candidates for TAVI was studied retrospecti... more Methods: A cohort of 35 consecutive patients who were candidates for TAVI was studied retrospectively. All of them had a fragility test divided in 4 grades. The tomographic analysis of the psoas was performed in a section perpendicular to the major axis of the muscle, at the level of the fourth lumbar vertebra. The parameters were: bilateral area, perimeter and muscle density and then ADPM. All parameters were categorized according to their 50th percentile value. Associations were explored using univariate logistic regression models.

Research paper thumbnail of P762Association between severe patient-prosthesis mismatch and prosthetic valve dysfunction following aortic valve replacement surgery with a biological prosthesis

European Heart Journal

Operative and minimal invasive options for treating heart diseases 125 to compare the risk of dev... more Operative and minimal invasive options for treating heart diseases 125 to compare the risk of developing infective endocarditis after TAVR implantation versus SAVR in patients with severe aortic stenosis. Methods: We performed a meta-analysis of 4 randomized studies comparing aortic valve surgery and TAVR in patients with severe aortic stenosis: PARTNER 1A, PARTNER 2, NOTION, US-Corevalve. Results: A total 3754 patients were included, of whom 1891 were assigned to TAVR and 1863 to surgery. The incidence of IE was very low in the first month after the procedure in both groups (0.05% versus 0.05%, p=0.98). During the first year, the incidence of IE was 0.8% in P. who underwent TAVR vs 0.9% in P. treated with surgery (p=0.80). In the maximum follow-up period (range 1-5 years) the incidence was 1.2% versus 1.0%, respectively, without statistical significant differences (p=0.58) (see figure). Conclusion: The risk of developing IE after treatment of severe aortic stenosis is low, either after trans-catheter aortic valve replacement or after surgery. No significant statistical differences were found between both groups.

Research paper thumbnail of Coronary Intramural Hematoma Visualized on Multislice CT Angiography

Revista espanola de cardiologia (English ed.), Jan 13, 2017

La disección coronaria espontánea es una causa poco frecuente de infarto agudo de miocardio. El h... more La disección coronaria espontánea es una causa poco frecuente de infarto agudo de miocardio. El hematoma intramural coronario se considera dentro del mismo grupo aunque no haya rotura intimal. Su diagnóstico angiográfico es difı́cil, porque el hematoma está en la pared del vaso, donde no penetra el contraste. Se expone el caso de una mujer joven, que sufrió un infarto agudo de miocardio con supradesnivel del segmento ST de cara anterior después de un episodio de estrés. Como se observa en la figura 1, la coronariografı́a evidencia un afinamiento marcado de la arteria descendente anterior desde su tercio medio a distal (resaltado en lı́nea de puntos), lo que suscitó la sospecha de hematoma intramural. Por su carácter no invasivo con respecto a otras técnicas de imagen intracoronaria, se realizó angiografı́a por tomografı́a computarizada (angioTC) multicorte para confirmar el diagnóstico y durante el seguimiento del paciente. En la angio-TC de la figura 2 también se observa una reducción de la luz y además un engrosamiento difuso de la pared (flechas), sin placas. En la figura 3 se compara la imagen con hematoma (figura 3A), tanto en la proyección multiplanar curva como en la ortogonal con engrosamiento difuso y concéntrico (flecha), con la angio-TC a los 45 dı́as, en la que el hematoma ha desaparecido (figura 3B, flecha). La repetición de la angio-TC fue muy útil para confirmar el diagnóstico y parece recomendable cuando haya dudas. En este caso, la angio-TC multicorte sirvió para confirmar la sospecha diagnóstica y descartar diagnósticos diferenciales, como ateroesclerosis o vasoespasmo coronario. Figura 1. Figura 2.

Research paper thumbnail of Lateral left ventricular wall rupture following acute myocardial infarction: pathophysiological interpretation by multimodality imaging approach

Echocardiography (Mount Kisco, N.Y.), 2014

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial in... more Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.

Research paper thumbnail of Aneurisma de Aorta Ascendente: ¿Cuál es el Riesgo de Reemplazar la Raíz?

Revista Argentina de Cardiología, 2018

Research paper thumbnail of Utility of Real Time 3D Echocardiography for the Assessment of Left Ventricular Mass in Patients with Hypertrophic Cardiomyopathy: Comparison with Cardiac Magnetic Resonance

Research paper thumbnail of Lateral Left Ventricular Wall Rupture Following Acute Myocardial Infarction: Pathophysiological Interpretation by Multimodality Imaging Approach

Echocardiography, 2014

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial in... more Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.

Research paper thumbnail of Hematoma intramural coronario visualizado en angio-TC multicorte

Revista Española de Cardiología, 2017

Research paper thumbnail of Long-term Outcome of Patients with Hypertrophic Cardiomyopathy

Argentine Journal of Cardiology, 2016

Introduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asocia... more Introduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asociada durante anos a altas tasas de morbimortalidad. Sin embargo, mucha de la informacion que tenemos en relacion a su evolucion proviene de centros en donde se incluyeron pacientes seleccionados, principalmente de alto riesgo. El proposito del siguiente trabajo es evaluar los eventos en el seguimiento de pacientes con MCH en nuestro medio. Metodos: Se evaluo una cohorte retrospectiva de pacientes con diagnostico de MCH. Se evaluo la evolucion de la clase funcional, junto con la ocurrencia de eventos clinicos. Se recabaron datos del ecocardiograma y de la resonancia magnetica cardiaca. Resultados: Se incluyeron un total de 259 pacientes, con una mediana de seguimiento de 3,5 anos (2-10). La edad promedio fue de 56 ± 16,8 anos y un 33 % tenian formas obstructivas. El 67 % de los pacientes estaban asintomaticos al inicio del seguimiento. En la evolucion, la mortalidad global fue del 1,6 %, co...

Research paper thumbnail of Evolución a largo plazo de pacientes con miocardiopatía hipertrófica

Revista Argentina de Cardiología, 2016

espanolIntroduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido... more espanolIntroduccion: La miocardiopatia hipertrofica (MCH) es una enfermedad compleja, que ha sido asociada durante anos a altas tasas de morbimortalidad. Sin embargo, mucha de la informacion que tenemos en relacion a su evolucion proviene de centros en donde se incluyeron pacientes seleccionados, principalmente de alto riesgo. El proposito del siguiente trabajo es evaluar los eventos en el seguimiento de pacientes con MCH en nuestro medio. Metodos: Se evaluo una cohorte retrospectiva de pacientes con diagnostico de MCH. Se evaluo la evolucion de la clase funcional, junto con la ocurrencia de eventos clinicos. Se recabaron datos del ecocardiograma y de la resonancia magnetica cardiaca. Resultados: Se incluyeron un total de 259 pacientes, con una mediana de seguimiento de 3,5 anos (2-10). La edad promedio fue de 56 ± 16,8 anos y un 33 % tenian formas obstructivas. El 67 % de los pacientes estaban asintomaticos al inicio del seguimiento. En la evolucion, la mortalidad global fue del 1,...

Research paper thumbnail of Abstract 16508: Fusion of 3D Echocardiography and Computed Tomography for Optimization of Cardiac Resynchronization Therapy

Introduction: A high percentage of patients do not respond to cardiac resynchronization therapy (... more Introduction: A high percentage of patients do not respond to cardiac resynchronization therapy (CRT), because the left ventricular (LV) lead is placed too far from the site of late myocardial activation. Optimal lead placement remains problematic, because different imaging modalities are used to depict coronary anatomy with high spatial resolution and LV wall dynamics with high temporal resolution. We hypothesized that fusion of computed tomography (CT) coronary veins with 3D transthoracic echocardiography (TTE) wall motion timing maps is feasible and may allow measurement of the distances between coronary veins and the site of late activation. Methods: In 9 patients with systolic heart failure (56+8 years, LVEF 34+9%), we obtained 3D full volume TTE of the LV and cardiac CT datasets. Prototype software (TomTec) was used to fuse coronary veins with 3D TTE parametric maps of the timing of LV wall motion superimposed on CT derived 3D endocardial surfaces. Distances were measured betw...

Research paper thumbnail of Hemodynamically significant prosthesis‐patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis

Echocardiography

To evaluate the accuracy of predicted prosthesis‐patient mismatch (PPM) regarding actual PPM meas... more To evaluate the accuracy of predicted prosthesis‐patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction.

Research paper thumbnail of Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

Revista Argentina de Cardiologia

Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsal... more Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of thecoronary arteries or preserving them is still a matter of debate.Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoingaortic root replacement versus aortic root surgery with sinuses of Valsalva preservation.Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoingurgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch,the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root;these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCOREand with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer inthe group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between bothgroups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272).Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years wassimilar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariateanalysis, age and mitral valve disease were identified as predictors of long-term mortality.Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is asafe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate ofevents or mortality at the long-term.

Research paper thumbnail of Desarrollo de un Programa de Oclusiones Totales Crónicas en la República Argentina - Colegio Argentino de Cardioangiólogos Intervencionistas

Revista Argentina de Cardioangiología Intervencionista

Research paper thumbnail of Average Density Of The Psoas Muscle Detected By Multislice Computed Tomography As A Measure Of Fragility In Candidates For Transcatheter Aortic Valve Replacement

Structural Heart

Methods: A cohort of 35 consecutive patients who were candidates for TAVI was studied retrospecti... more Methods: A cohort of 35 consecutive patients who were candidates for TAVI was studied retrospectively. All of them had a fragility test divided in 4 grades. The tomographic analysis of the psoas was performed in a section perpendicular to the major axis of the muscle, at the level of the fourth lumbar vertebra. The parameters were: bilateral area, perimeter and muscle density and then ADPM. All parameters were categorized according to their 50th percentile value. Associations were explored using univariate logistic regression models.

Research paper thumbnail of P762Association between severe patient-prosthesis mismatch and prosthetic valve dysfunction following aortic valve replacement surgery with a biological prosthesis

European Heart Journal

Operative and minimal invasive options for treating heart diseases 125 to compare the risk of dev... more Operative and minimal invasive options for treating heart diseases 125 to compare the risk of developing infective endocarditis after TAVR implantation versus SAVR in patients with severe aortic stenosis. Methods: We performed a meta-analysis of 4 randomized studies comparing aortic valve surgery and TAVR in patients with severe aortic stenosis: PARTNER 1A, PARTNER 2, NOTION, US-Corevalve. Results: A total 3754 patients were included, of whom 1891 were assigned to TAVR and 1863 to surgery. The incidence of IE was very low in the first month after the procedure in both groups (0.05% versus 0.05%, p=0.98). During the first year, the incidence of IE was 0.8% in P. who underwent TAVR vs 0.9% in P. treated with surgery (p=0.80). In the maximum follow-up period (range 1-5 years) the incidence was 1.2% versus 1.0%, respectively, without statistical significant differences (p=0.58) (see figure). Conclusion: The risk of developing IE after treatment of severe aortic stenosis is low, either after trans-catheter aortic valve replacement or after surgery. No significant statistical differences were found between both groups.

Research paper thumbnail of Coronary Intramural Hematoma Visualized on Multislice CT Angiography

Revista espanola de cardiologia (English ed.), Jan 13, 2017

La disección coronaria espontánea es una causa poco frecuente de infarto agudo de miocardio. El h... more La disección coronaria espontánea es una causa poco frecuente de infarto agudo de miocardio. El hematoma intramural coronario se considera dentro del mismo grupo aunque no haya rotura intimal. Su diagnóstico angiográfico es difı́cil, porque el hematoma está en la pared del vaso, donde no penetra el contraste. Se expone el caso de una mujer joven, que sufrió un infarto agudo de miocardio con supradesnivel del segmento ST de cara anterior después de un episodio de estrés. Como se observa en la figura 1, la coronariografı́a evidencia un afinamiento marcado de la arteria descendente anterior desde su tercio medio a distal (resaltado en lı́nea de puntos), lo que suscitó la sospecha de hematoma intramural. Por su carácter no invasivo con respecto a otras técnicas de imagen intracoronaria, se realizó angiografı́a por tomografı́a computarizada (angioTC) multicorte para confirmar el diagnóstico y durante el seguimiento del paciente. En la angio-TC de la figura 2 también se observa una reducción de la luz y además un engrosamiento difuso de la pared (flechas), sin placas. En la figura 3 se compara la imagen con hematoma (figura 3A), tanto en la proyección multiplanar curva como en la ortogonal con engrosamiento difuso y concéntrico (flecha), con la angio-TC a los 45 dı́as, en la que el hematoma ha desaparecido (figura 3B, flecha). La repetición de la angio-TC fue muy útil para confirmar el diagnóstico y parece recomendable cuando haya dudas. En este caso, la angio-TC multicorte sirvió para confirmar la sospecha diagnóstica y descartar diagnósticos diferenciales, como ateroesclerosis o vasoespasmo coronario. Figura 1. Figura 2.

Research paper thumbnail of Lateral left ventricular wall rupture following acute myocardial infarction: pathophysiological interpretation by multimodality imaging approach

Echocardiography (Mount Kisco, N.Y.), 2014

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial in... more Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.